MC Community Services Employment Application

Employment Application
Employees of MC Community Services and applicants for employment shall be afforded equal opportunity in all aspects of employment without regard to race, color, religion, political affiliation, sexual orientation, national origin, disability, marital status, gender, or age. As a means of accommodation for persons with specific disabilities that prevent them from completing this application, confidential assistance in filling out this application may be obtained by calling us. We welcome diversity in the workplace.
Personal Information
Legal Name*

First NameLast Name
Other names by which you have been known
Current Address*

Street Address

Street Address Line 2

CityState

Zip Code
Previous Address (If at current address less than 3 years)

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Date of Birth*

MonthDayYear
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Driver's License Number*
Position Desired
Behavioral Health Professional (BHP)SupervisorOffice StaffOther
Full TimeTemporaryPart Time
Desired Start Date*

MonthDayYear
Date
Desired Pay Rate
YesNo
YesNo
YesNo
Note: Proof of citizenship is required to complete required documentation prior to starting employment.
Education
YesNo
Employment History and References
Please attach a copy of your current resume.
Resume Upload*

Cancelof
Please describe your reason for leaving your most recent employer.*
Would your most recent employer rehire you? Why or why not?*
Upload a document that includes 3 professional or personal references

Include the following information for each reference:
- Name
- Company name and address
- Years Acquainted
- Telephone number
- Email address
References document upload*

Cancelof
Criminal History
YesNo
If yes, give a brief explanation
Insurance and Certifications
YesNo
If yes, give a brief explanation
YesNo
YesNo
YesNo
If yes, provide a list of your additional certifications
MC Community Services is contracted through the Maine Department of Health and Human Services (DHHS) and is Trauma-Informed and Co-Occurring Aware.
YesNo
If yes, give a brief explanation
Please list any conferences, in-services, or trainings you have attended
Future Growth with MC Community Services
Why are you interested in becoming an MC Community Services employee?*
What are your career goals?*
Please tell us about your professional accomplishments*
Additional Information
LincolnHowlandLeeMiloEast MillinocketMillinocketMedwayGreenvilleOld TownBangorBradfordWoodvilleDanforthSpringfieldMattawamkeagOther
Describe your general availability (days, afternoons, evenings, weekdays, weekends) *
Let us know about anything you anticipate that will change your availability
FlyerAdvertisementSocial mediaWord of mouthCurrent employeeOther
Please let the current employee who referred you
I hereby certify that all entries in this application and any attachments are true and complete, and I agree and understand that any falsification of information herein, regardless of time of discovery, may cause forfeiture on my part of any employment with MC Community Services. I understand that all information on this application is subject to verification and I consent to criminal history background checks. I also consent to references and former employers and educational institutions listed being contacted regarding this application. I further authorize MC Community Services, to rely upon and use, as it sees fit, any information received from such contacts. Information contained on this application may be disseminated to other agencies, nongovernmental organizations or systems on a need-to-know basis for good cause shown as determined by the agency head or designee.
Today's Date*

MonthDayYear
Date
Signature*
Should be Empty:

Employment Application

Personal Information

Position Desired

Education

Employment History and References

Criminal History

Insurance and Certifications

Future Growth with MC Community Services

Additional Information